Pes Planus is a general medical term used to describe the flat-footed condition. It is also referred to as pesplanovalgus, fallen arches, and over pronation.You may have noticed a family member or friend when they take off their shoes and socks, that their feet may tend to “widen” when standing and bare, as they are no longer supported by a shoe. The medial arch in one or both feet becomes unsupportive, resulting in the affected foot (feet) to be flat, especially during any weight-bearing activity. Adult Pes Planus affects many men and women throughout the world, and can result in foot, ankle, knee, hip, or spinal discomfort as well as increase the chances of injury. This can be corrected with proper foot wear and custom foot orthotics.
What is a “flat foot”?
A true flat foot is very rare with an estimated prevalence of only 1.8% of the adult population. This condition is referred to as rigid pes planus, whereby the foot is completely flat even during non-weight bearing. Rigid pes planus is a pathologic condition and often occurs in conjunction with an underlying disease.
Flexible (or functional) pes planus is a biomechanical problem experienced by a surprisingly high percentage of the population (up to 20% of the population). In this case the arch will appear normal when the person is sitting (i.e. not bearing weight). However with the person standing upright you will be unable to place an index finger under the arch. The entire bottom of the bare foot is in contact with the floor or ground surface during standing, walking, and other weight bearing activities.
Flexible pes planus can be caused by ligament or tendon laxity, and severe excess subtalar (ankle) joint pronation, which leads to excessive calcaneal (heel bone) eversion during the contact phase of gait. This lack of arch support causes the feet to flatten, creating an unstable position for the ankles, and inward rotation of the knees. This inward rotation can also affect the hip joint, sacroiliac joint, and even change the alignment of the spine. In each of these areas, the resulting improper biomechanics can be silent or commonly result in ankle, knee, hip and lower back pain. I have even seen alignment changes as high as the cervical spine (neck) from improper foot alignment. This is why a proper examination of anyone with spinal, pelvic, hip or knee complaints should always include an assessment of the feet!
If left uncorrected, this condition can lead to other painful foot conditions such as plantar fasciitis (inflammation of the bottom of the feet), hallux valgus (bunions) and arthritic changes to various joints.
Although this condition doesn’t cause pain to everyone with flat feet, it can be a problem during exercise, a change in job environment, or when walking. What the literature tells us about the flat foot and how it relates to pathology is telling. Research has shown that an increase in plantar surface contact area, associated with pes planus can be a risk factor for the development of overuse injuries and increase the risk of injuries in sports.
Pediatric pes planus is a normal condition in infancy. The arch develops gradually during childhood. Thus, pes planus is normal in infants, common in children, and often present in adults. Its prevalence decreases with age. Commonly, by the age of 5-6 years old, children should have developed a visible arch.
How do we determine if you have Flat Feet?
A simple test is to put slide your index finger under the medial arch of your foot. You should be able to slide your finger in to at least the first finger joint.
People with flat feet will often also notice that footwear may be worn unevenly.
What’s more important is to see how your flat feet affect your biomechanics. At our office we perform a Digital Gait Analysis. This involves walking across a computerized pressure pad which measures the timing of various important biomechanical markers of your feet in speeds up to 60 frames per second, which is much faster than the human eye. It can show us how various bones move, the pressure in various parts of your feet throughout the gait cycle and the appropriate timing of your feet relative to normal. This will help us to discover any biomechanical abnormalities that may be putting undue stresses on your feet and alignment of your spine such as flat feet. The information obtained can also help us to design custom foot orthotics if necessary.
How do we fix Flat Feet?
Doctors can help patients overcome this painful condition with conservative treatment:
Foot orthotics allow the muscles, tendons and bones of the feet and lower legs to function at their highest potential. When appropriately prescribed, orthotics can decrease pain, not only in the foot, but in other parts of the body such as the knee, hip and lower back. They can also increase stability in an unstable joint, prevent a deformed foot from developing additional problems, correct improper biomechanics and improve overall quality of life. For athletes this can mean improvement in performance and decreasing the chance of injury.
Often people will have Extended Health Insurance benefits that cover the cost of orthotics. Please check your individual health benefits package.
To learn more about custom-made foot orthotics, please click on the following link.
Footwear is a major player in treatment for patients with flat feet. Flat footwear such as shoes without arch support and flip flops only add to the problem. People with flat feet should wear spacious footwear that is comfortable and provides adequate support from the foot bed.
If you believe that you, or someone you know, may have flat feet, call the office today to schedule a check-up appointment, and foot examination and find out what treatment options are available to you.
~ Dr. Gertz
The information contained in these newsletters is designed to provide general information and to promote greater health. Every individual should seek the advice of their chiropractor or healthcare provider for diagnosis and advice before changing or adding any product or treatment to their health regime.